Healthcare Professional | Medical Coding and Billing Specialist
6 days ago
As a Medical Coding Specialist, you will be responsible for conducting thorough research and identifying Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria.
This involves reviewing clinical content and providing written and oral presentations to medical directors and other clinical colleagues to obtain consensus on proposed denial criteria.
- Research and identify medical coding and billing documents to determine claim eligibility.
- Provide written and oral presentations to medical directors and other clinical colleagues.
- Collaborate with cross-functional teams to ensure accurate and timely claim processing.
- Develop and maintain in-depth knowledge of medical coding systems, including ICD-10-CM and CPT.
Required Qualifications:
- Bachelor's Degree in Nursing.
- Active RN (PRC) License.
- CCS-P or CPC certification.
- At least 5 years of experience in medical coding, claims denials, and chart review/auditing.
- Previous experience working with US health insurance payers is required.
- Excellent communication skills and proficiency in MS Office applications are essential.
Additional Responsibilities:
- Perform data entry of clinical content updates into the database.
- Solve problems related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines.
Seniority level: Mid-Senior level
Employment type: Full-time
Job function: Healthcare Provider
Industry: Outsourcing and Offshoring Consulting
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